HAYDEN, Idaho — Mary Suitter is sporting fresh bandages on her face and arm, markers of two new biopsies that may reveal yet another bout with melanoma.

Though she lacks conventional health insurance, the 57-year-old mother of four says she isn’t worried about the costs of a recurrence of her 2006 diagnosis with the deadliest form of skin cancer.

Suitter — and her husband, Mike, a handyman and builder — are members of a health care sharing ministry, a religious co-op whose participants agree to support each other — and to pay each others’ medical bills.

“The Bible says to bear one another’s burdens,” says Mary Suitter, who has a sheaf of cards, letters and notes that arrived with small checks from Christians across the country, funds totaling more than $35,000 to cover her family’s expenses over the past four years.

The Suitters are among more than 100,000 people in the United States whose care is compensated not through guaranteed insurance payments, but through faith that fellow believers will foot the bills. Christians who regularly attend church usually sign up as individuals, but they’re part of a larger community that pays for ailments from broken legs to brain tumors, so long as they meet ministry guidelines.

The arrangements have drawn new attention following President Barack Obama’s signing last month of the
health care reform law
, which specifically exempts members of health care sharing ministries from so-called “pay or play” taxes on mandatory health insurance.

That means the Suitters can all but ignore the new law, which takes effect in 2014 and requires that most people buy health insurance or face a fine that starts at $95 for individuals and $285 for families, or 1 percent of income, whichever is greater, and rises to $695 for individuals and $2085 for families or 2.5 percent of income by 2016.

Ministries say they care for their own
Officials with the Suitters’ Christian co-op, Samaritan Ministries International, and other health care sharing groups say they lobbied federal legislators aggressively for the exemption, claiming that their members cover their own medical needs, providing their own kind of care.

“Our argument was, we’re not part of the problem, we’re continuing to be part of the solution,” said James Lansberry, vice president of Samaritan, which serves some 14,000 families. “Our members are here, they’re paying their bills.”

It’s the same argument used by other recognized religious groups, including the Amish, whose members long have been able to be exempted from paying taxes for Social Security and Medicare. Based on that exemption, such groups may also opt out of the mandatory insurance requirement under the new law.

Experts caution, however, that the religious exemption won’t apply to just anyone who claims a faith-based objection to paying for health insurance. Christian Scientists, for example, can qualify for tax breaks, but church leaders now are telling members they're not eligible for the health exemption because care is not guaranteed within the community, said Russ Gerber, media manager for the First Church of Christ, Scientist in Boston.
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“The aim of this was to primarily cover those religious organizations that self-fund their health care,” Gerber says. “We’re not in it.”

Ultimately, the religious exemption likely will apply to a narrow range of faiths, and it’s not clear which will have successful petitions, notes Lloyd Hitoshi Mayer, a tax law expert and associate professor at the Notre Dame Law School. “It requires pretty substantial evidence that you are, in fact, committed to the full tenets of this group,” he added.

Committed faith, biblical lifestyle
Committed faith is a key for health care sharing ministries, whose organizers say they expect an influx of inquiries from people wanting to avoid insurance or fines. Under the health care law, ministries must have been in existence since at least Dec. 31, 1999, must retain members even after they get sick and must conduct annual audits.

The ministries operate across state lines, with members from far-flung regions sharing costs. Samaritan, for instance, has about 46,000 members in all 50 states, the District of Columbia, Puerto Rico, the U.S. Virgin Islands and in places where U.S. missionaries are based abroad.

The health care ministries work by asking members to contribute monthly payments, or “shares,” which pay for a wide range of needs. A March newsletter for Samaritan includes requests for payment for hip replacement surgery, colon cancer and complications from a heart attack, among other ailments.

The three largest sharing ministries say they each process between $2 million and $3.5 million in medical needs each month, paying bills that range from several hundred dollars to $500,000 or more.

In return, members agree to adhere to a so-called biblical lifestyle. At Samaritan, which is based in Peoria, Ill., members are expected to attend church three out of every four Sundays and to submit verification signed by a minister.

The Suitters say they regularly attend two churches, the Coeur d’Alene Bible Church and Real Life Ministries, a large Evangelical Christian church with more than 7,000 members in Kootenai County, Idaho.

Ministry members are asked to agree to Christian tenets of faith and to adhere to healthy choices that prohibit smoking, illegal drugs and alcohol abuse.

At Christian Care Ministry of Melbourne, Fla., which operates the Medi-Share program, members might be disqualified if they are significantly obese or are at risk for serious disease, according to the group’s guidelines, although President Robert Baldwin says most are asked to join a group that provides spiritual and nutritional counseling.

“Our goal is to keep the shares as affordable as possible,” said Baldwin. “It’s not like we’re the lifestyle police.”

Fees range from $45 to $600 a month
The monthly shares amount to the equivalent of an insurance premium — from as little as $45 to as much as $600 each month. At Samaritan, members pay a $170 annual administrative fee and then a monthly share depending on their family size. For the Suitters, for instance, the cost is $240. Some groups require payment directly to the patient while others, such as Christian Healthcare Ministries of Barberton, Ohio, process the fees through a central office.

In the Suitters’ case, they get a letter each month assigning them a specific person or family to help. In March, their payment went to a 16-year-old New Mexico boy who had foot surgery. Members are asked to send along a card or note of encouragement as well.

“It’s such a blessing to read their stories and to help people,” says Mary Suitter. “It makes you want to send extra.”

And those who’ve been helped say it’s a blessing as well. Tracy Kamprath, 49, of Chappel Hill, Texas, admits she had doubts about the program when she was diagnosed with a brain tumor two years ago.

“We weren’t sure, but we joined in faith,” said Kamprath, a former Christian school teacher whose family had no other option for health insurance when they signed up two years before she became ill.

Jed Conklin
/
for msnbc.com

Mike Suitter, 57, re-reads one of hundreds of letters and cards he and his wife, Mary, received from Samaritan members — along with checks — during recent illnesses.

The bill for her successful treatment topped $240,000, but with discounts for paying cash and some negotiations with providers, the Kampraths were able to reduce it to $60,000, which was covered by dozens of Samaritan members.

“Every penny was paid for,” she said.

Nearly all needs are met, share ministry organizers say. If there are more bills than payments, Samaritan prorates reimbursement to 80 percent of the cost, but asks members to pay more if they can. In nearly every instance, the extra funds show up, Lansberry says.

There are instances where members don’t pay their shares and where administrators have to remind them, or in some cases terminate membership. But organizers say such incidents are relatively rare in a system fueled by faith, where members often contribute to medical needs that aren’t covered under program guidelines.

Although everyone is strongly encouraged to pay, for those who can’t afford all or part of the fees, Samaritan has a sponsorship program that asks other members to provide.

‘We really believe in this’Mike Suitter, 57, suffered a brief mental illness two years ago — a breakdown partly fueled by stress over the effects of the recession on the construction industry, he says. He was hospitalized for 15 days in a psychiatric ward. Mental health treatment, like dental and vision care, is not routinely covered under the sharing plans. Most plans also exclude nearly all preventive care and a long list of pre-existing conditions.

Baldwin explains that families are expected to take care of routine medical care on their own, and not rely on fellow members to help with that.

Health care's fate in grandma's hands?Still, families can ask for help with costs outside the covered expenses. The Suitters said they received $14,000 in “love gifts,” about half the total cost of his care.

“It has just given me such faith,” Mary Suitter said. “We really believe in this.”

Not everyone is so enthusiastic about health care sharing ministries. Insurance officials from Maine and Illinois to Montana have battled with the programs, which some say operate as unregulated insurance, potentially confusing consumers.

“People often participate in sharing arrangements assuming that they are purchasing health insurance,” said Michael McRaith, director of the Illinois Department of Insurance. “There is no protection or assurance for that individual who’s sick that the sharing ministry is going to cover those expenses.”

Sharing ministry officials point to their enrollment agreements and guidelines, which specifically state that they are not insurance programs because there’s no guarantee of coverage.

“We don’t guarantee that people will get a single dollar,” Lansberry says. “It’s a faith-based ministry and there’s a certain amount of faith attached to that.”

The federal exemption to mandatory insurance may fuel even more interest in the health care sharing ministries. Samaritan is already enrolling 200 new members a month, Lansberry says, numbers that may grow as the 2014 deadline for mandatory insurance looms.

Mike and Mary Suitter say they’re relieved that they won’t be forced to buy insurance or pay fines when they’ve already made proven arrangements for their health care costs. It’s still too soon to know the results of Mary’s biopsies, but the couple say they have faith her health care needs will be covered.

“If we hadn’t received the exemption, I’d feel pretty violated that my freedoms had been taken away,” Mike Suitter says.

That’s fine, say regulators like McRaith, who recognizes the value of faith-based care so long as people know what they’re getting into.

“Understand what it is,” McRaith says. “Consumers should make an educated decision about whether faith alone is enough for your family’s medical security.”